Shri Amarnathji Yatra 2018

YATRA PERMIT Applicant’s

APPLICATION FORM photograph
(Please fill in block letters) which should
be signed
across this
photograph
FULL NAME: _________ ____________________________________________
GENDER (Tick as applicable): Male Female; ; Blood Group:_______
√
√ (No one below the age of 13 years, or above the age of 75 years will be registered for the Yatra).
Age*:______ Yrs.
NAME OF SPOUSE / FATHER:_________________________________________________
ADDRESS:___________________________________________________________________
STATE: _____________________________________ PIN________________________
E-Mail (if any):____________________________________________________________

CONTACT / PHONE NO MOBILE +91

Telephone with STD Code / Mobile number of the person to be contacted in case of any emergency
__________________________

To
The Chief Executive Officer,
Shri Amarnathji Shrine Board,
Jammu / Srinagar.
Sir,
1. I may please be issued a Permit for embarking on Shri Amarnathji Yatra. I shall
start the Yatra from the _________________ _____ [Baltal / Chandanwari**] route
on__________ / __________ 2018.

2. I certify that I have been declared physically fit by the Authorised Doctor / Medical
Institute to undertake the journey to the Shri Amarnathji Holy Cave during June-
August 2018. The prescribed Medical Certificate is attached.

3. I_____________________ , son / daughter / wife of________________ , nominate

Shri / Smt. _________________________________ ; age ________ ; relationship:
__________ to be paid the Insurance proceeds*** upon payment of the Insurance
claim in case of my death due to accident.

4. I solemnly undertake to abide by the Dos & Don’ts / other directions issued by the
Shrine Board / District Administration.

______________________
Full Signature of Applicant
* No one below the age of 13 years, or above the age of 75 years, and no lady with more than six weeks
pregnancy will be registered for the Yatra.
Please fill whichever is applicable.
*** A duly registered Yatri with a valid Yatra Permit issued by the Shri Amarnathji Shrine Board, duly endorsed by the issuing
Institution, will be entitled to an Insurance cover of Three Lakh Rupees from the Insurance Company in the event of her/ his death
due to any accident inside the State of J&K while undertaking the Shri Amarnathji Yatra. The sum assured will be paid
through the Shrine Board after the nominee of the deceased Yatri completes the due formalities.

For Office Use Business Unit ___________ Branch

Bank Yatra Registration Slip No. _________ Date _______ Route ____________ issued

Seal and Signature of Initials of Official

Registration Officer